One of the many challenges of the coronavirus pandemic is trying to stay mentally and physically healthy in the absence of traditional social support networks. The stay-at-home orders in place in many states around the United States mean that working, learning, and socializing must happen remotely. For people who are addicted to drugs or alcohol or are in recovery from addictions, the loss of face-to-face therapy and group meetings can be especially difficult to manage.
For many people, their recovery has been built on an infrastructure of community and social support, says Justine W. Welsh, MD, director of addiction services at Emory Healthcare and an assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta.
“While this shift has been easy to adapt to for some individuals, it’s been less so for others. There have been increasing issues associated with social isolation, and my own clinic has witnessed an increase in the severity of substance use,” says Dr. Welsh. “I’ve been hospitalizing patients more frequently than I usually do because of safety concerns around depression, increase in substance use, and dangerous behaviors; it’s been really challenging,” she says.
In addition to the isolation, the loss of a job or financial stability can be a significant stressor that can lead people to turn to substances more frequently, even for people who didn’t have a preexisting substance use disorder, says Welsh.
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Telemedicine and Telehealth Can Offer Some Advantages Over In-Person Visits
Pre-COVID-19, it was very hit or miss whether a local psychiatry or mental health clinic offered telemedicine, but now almost every practice has made the transition, in some cases literally overnight, says Anna Lembke, MD, an associate professor and medical director of addiction medicine at Stanford University School of Medicine in Palo Alto, California.
“Many HIPAA [Health Insurance Portability and Accountability Act of 1996] and prescribing regulations have been waived in order to allow us to treat people remotely,” she says. Compared with other medical specialties, it’s an easier transition to telemedicine for psychiatry and mental health, because there isn’t as much reliance on the physical exam, although it can still be important, says Dr. Lembke.
In the addiction and recovery world, there is a distinction between telehealth and telemedicine:
- Telemedicine uses a platform (such as Zoom or one more secure) to provide patient care and clinical services that are typically billed to insurance or the patient.
- Telehealth, on the other hand, includes online recovery resources that can be part of patient treatment or self-directed recovery but are not billable services.
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Addiction and COVID-19: A Range of Responses
“I’m seeing a full range of reactions to COVID-19 in my clinic,” says Lembke. “I certainly have patients who are experiencing what you might intuitively think — anxiety, isolation, depression, and lots of increased urges to use. I’ve had patients who have relapsed,” she says.
There are also patients who have said that COVID-19 has been really good for them in terms of their recovery, says Lembke. “It’s quieted down all the noise in their lives and removed many of the triggers to use.”
Telehealth and Telemedicine Can Remove Some Barriers to Getting Help
“For a number of patients using telehealth or telemedicine has been a positive, because it allows them to overcome a number of barriers that would have existed for them,” says Welsh. Because there aren’t enough substance use treatment centers, particularly in rural areas, transportation and travel time can be a real issue, she says.
“Patients can be driving 90 minutes to two hours to seek treatment, which really reduces the frequency with which they can attend. Telehealth can enable them to have more frequent appointments, and they’re not having to pay money for gas or find transportation,” says Welsh.
Many People Are Trying Out Telehealth and Telemedicine for the First Time
There have been a lot of new patients since the start of the pandemic, according to Lembke. “It almost seems like COVID-19 has been sort of a reset for people who want to get their house in order, maybe because they have a little more time or time to reflect,” she says.
“We refer a lot of patients to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and we’ve had some patients be more willing to try them than they were prior to COVID-19, because all of the AA meetings are now online instead of in person,” says Lembke. “Some people were really worried about anonymity when they go to these meetings — they didn’t want to run into anyone they might know. Online you can register on Zoom with a pseudonym and join a meeting without showing your face. Now people are able to have the AA experience in a way that’s even more anonymous,” she says.
“It has been a positive for us that there are online recovery resources at our disposal, says Welsh. “I think we’re seeing more patients engaged in those, either because they have more free time, or the groups are more accessible because of people’s schedules and an increase in the number of meetings, so that’s been a positive,” she adds.
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Resources for Getting Help and Support for Substance Abuse
Online AA Meetings and Online Group AA Meetings
AA, or Alcoholics Anonymous, is a place where men and women come together to share their experience, strength, and hope with each other to stop drinking and recover from alcoholism. The AA program is set forth in 12 steps as a way to help people have a fulfilling life without alcohol. There are email, chat, audio, and video options.
Recovery Dharma is a peer-led community that uses the Buddhist practices of meditation, self-inquiry, wisdom, compassion, and community as tools for recovery and healing. The movement welcomes anyone who wants to heal from addiction and addictive behavior that creates suffering, including substance use.
In the Rooms is a free online recovery tool that offers 130 weekly online meetings for those recovering from addiction and related issues. The organization was created as a way to give recovering addicts a place to meet and socialize when they’re not in face-to-face group meetings. In the Rooms embraces multiple pathways to recovery, including all 12-step, non-12-step, wellness, and mental health modalities.
Al-Anon is a support program for people whose lives have been affected by someone else’s drinking. They are now holding electronic meetings to offer help and hope in the spirit of the 12 traditions.
SAMHSA’s National Helpline, 800-662-HELP (4357) (also known as the Treatment Referral Routing Service) or TTY, 800-487-4889, is a confidential, free, 24-hour-a-day, 365-day-a-year information service in English and Spanish for individuals and family members facing mental illness or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.
This 12-step recovery program is based on the AA 12 steps and 12 traditions with a broadened approach that includes all drugs. People share thoughts or readings on video or conference call–style meetings. Meetings are designated “open” or “closed”; closed meetings are only for those who identify as addicts, and open meetings are open to all, but sharing is restricted to only those who identify as addicts.
SMART Recovery has had a pretty strong online presence for a number of years, says Welsh. “Instead of being based on the 12 steps, it’s based in cognitive behavioral therapy and teaches coping and management skills for substance abuse,” she says. “I’ve had a number of my patients using SMART Recovery even pre-COVID-19, and I recommend both 12-step groups and SMART Recovery as options to my patients.
Marijuana Anonymous is a group that shares experiences, strength, and hope to help people recover from marijuana addiction. Phone and online meetings are available to everyone.
The Herren Project began in 2011 by former pro basketball player Chris Herren, with the stated goal of helping people navigate the road to recovery from the disease of addiction. The live virtual online support groups and recovery meetings are moderated by trained clinicians and offered at no cost.
Apps for Addiction and Recovery
Apps are a popular tool in the recovery world, says Lembke. “I have lots of patients who use these, especially those who have an abstinence goal — there are some apps that can count the number of days a person has been without drugs or alcohol,” she says.
There are also good apps for people trying to reduce or be more moderate in their consumption. “They can help keep track of quantities or frequency that a person is using their drug of choice to make sure that they stay within certain limits,” says Lembke.
This app from the Addiction Policy Forum and CHESS Health can help people track their sobriety, access e-therapy to learn new recovery skills, connect with trained counselors and peers, and access a variety of resources, including videos and testimonials.
The Loosid app connects users with a community of like-minded individuals and gives access to tailored experiences, including dating, events, groups, travel, and a suite of recovery tools for extra support.
If You Need Support, Stay Open and Embrace Change
Welsh recommends trying to embrace the virtual community as much as possible during this time. “It can be a recovery community or family and friends that you connect with online or by phone. Be willing to learn something new and try things out that maybe you wouldn’t have tried before,” she says. “I’ve had a number of patients shy away from using online resources pre-COVID-19, and this has given them an opportunity to try something new that might work for them,” says Welsh.